Most practice owners plan for one version of the future: whatever they hope happens. That works fine until a slower-than-expected January catches the practice without a plan for covering payroll and overhead during the lean stretch. Scenario planning fixes this by building out more than one version of what the next few months could look like, so you're not caught off guard by whichever one actually happens.

The approach we build for clients uses three scenarios. Base case is your realistic expectation, built off historical numbers from previous years adjusted for anything specific to this year. Best case models what happens if things go better than expected, maybe strong new patient conversion from a fall marketing push or better-than-usual patient retention through the holidays. Worst case models a genuinely slow stretch, the kind of January where new patient volume drops and existing patients delay care longer than usual.

Building this isn't about predicting the future perfectly. It's about knowing, ahead of time, what decisions each scenario would call for, so you're not making those decisions under pressure in the moment. If the worst case scenario shows cash getting tight by February, that's useful information in September, while there's still time to build a reserve, adjust staffing plans, or hold off on a planned expense before you actually need to.

We set this up for practice clients in Google Sheets connected to their real financial data, with toggles that let you switch between scenarios and immediately see how each one plays out across revenue, expenses, and cash position over the coming months. It's the same base/best/worst framework we use in the dashboards we build for other clients, applied specifically to your practice's seasonal patterns.

The practices that get through a slow Q1 without real stress aren't the ones that got lucky. They're usually the ones that looked honestly at the worst case scenario back in September and made a few adjustments while there was still time for it to matter.

Jeremy Brewer is the founder of 911 Bookkeepers LLC in Baton Rouge, Louisiana. 911 Bookkeepers partners with MBJA Accounting Service to give chiropractic and MDVIP practices clean, current financials. He is a Xero Certified Advisor.